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Obstetrics n Gynaecology MADE

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CLINICAL CASES (OBSTETRICS)


CASE 1 ANEMIA IN PREGNANCY
CASE 2 PREGNANCY INDUCED HYPERTENSION (PRE-ECLAMPSIA)
CASE 3 PREVIOUS CAESAREAN SECTION
CASE 4 Rh NEGATIVE PREGNANCY
CASE 5 HEART DISEASE IN PREGNANCY 1
CASE 6 HEART DISEASE IN PREGNANCY 2

Name Vasanthamma
Age 30 years
Address Nelamangala
Occupation Housewife
Religion Hindu

1. CASE OF ANAEMIA IN PREGNANCY


HusbandS Name Bailanjappa
Age 35 years
Occupation Coolie
Income Rs. 3300/month
SE Status Upper Lower class

G3P2L2 comes with 8 months of amenorrhea


PRESENTING COMPLAINTS Easy fatigability since 2 months
HISTORY OF PRESENTING COMPLAINTS:

Patient presents with 8 months of amenorrhea with easy fatigability since 2 months. Previously,
the patient was able to do her household work, but for the past 2 months, she gets tired even with
minimal work. On walking about 50 m, patient complains of fatigability, giddiness, blurring of vision
which is relived on rest.

No history of increased bleeding during menses prior to pregnancy.

No history of exertional dyspnea, palpitation, PND, pedal edema or giddiness.

No history of bleeding or leak PV.

No history of bleeding PR or malena.


No history of passing worms in the stools.
No history of fever with chills and burning micturation.
No history of cough with expectoration, hemoptysis, evening rise of temperature or contact with a
known case of tuberculosis.
No history of drug intake (anti-malarial drugs or aspirin).
No history of any yellowish discolouration of skin and sclera.
Not a known diabetic or hypertensive.

OBSTETRIC HISTORY:
Married Life 13 years, Non-consanguinous
Obstetric index G3P2L2

No
.

G1

G2

DELIVERY

BABY AT
BIRTH

FTND,
Government
Hospital

Cried soon
after birth,
Male, 3.2 kg,
Breast fed 3
years

FTND,
Government
Hospital

Baby cried
soon after
birth,
Female, 3
kg, Breast
fed 2
years

PRESENT
AGE

12 years

10 years

LMP 02/11/2006
EDD 09/07/2007
PRESENT PREGNANCY
T1

No history of nausea, vomiting or weakness.

No urinary symptoms

No drug intake

No history of craving for abnormal food (pica)


T2

Quickening in 5th month


1st ANC visit 20 weeks, given TT & IFA tablets (consumed)

T3

Fetal movements present


No leak or bleed PV
No h/o pain abdomen

COMMENTS
Booked &
Immunized(Had 3
ANC visits + TT +
IFA)Post partum
period normal

Booked &
Immunized(Had 3
ANC visits + TT +
IFA)Post partum
period normal

CONTRACEPTIVE HISTORY:
No history of using any contraceptive methods.
MENSTRUAL HISTORY:
Age of Menarche 13 years
Past Cycles Regular 30 days cycles with flow lasting 5 days, normal quantity, no pain or passing of
clots.
LMP 02/11/2006
FAMILY HISTORY:
No history of congenital anomalies or twinning, DM, HTN
PAST HISTORTY:
No history of Tuberculosis, Epilepsy, Asthma
No history suggestive of any cardiac ailments.
No history of previous surgeries, blood transfusions.
PERSONAL HISTORY:
Diet Mixed
Appetite Good
Sleep Sound
Bowel & Bladder Regular
Habits Nil
DIET HISTORY:
Consumes 2100 kcal/day
Required 2400 kcal/day
Deficit 300 kcal/day
GENERAL PHYSICAL EXAMINATION:
Here is a pregnant lady 30 year old, moderately built and nourished, conscious, alert & cooperative.
Pulse
BP
RR
Temperature

84/min, regular, good volume


110/68 mm of Hg
14/min, regular
Patient is afebrile

Pallor
Icterus
Cyanosis
Clubbing
Edema
Lymphadenopathy

Present
Absent
Absent
Absent
Absent
Absent

Thyroid
Breasts
Spine

Normal
Normal
Normal

Height
Weight
BMI

146 cm
56 kg
26.27

SYSTEMIC EXAMINATION:
CVS S1 S2 heard, No murmurs.
RS NVBS heard, no basal crepts.
CNS NAD.
PA Normal bowel sounds heard
OBSTETRIC EXAMINATION:
INSPECTION:

Abdomen is uniformly distended, globular in shape

Umbilicus everted, hernial orifices normal

Flanks do not appear to be full

Stria gravidarum and linea nigra present

No scars over the abdomen


PALPATION:

Abdominal circumference 76 cm

Symphysio-fundal height 28 cm (corresponds to 32 weeks)

FUNDAL GRIP Soft, broad & non-ballotable, suggestive of breech

Lateral Grip Knob like structures on the right side suggestive of limb buds
Uniform resistance on the left side suggestive of spine

1ST PELVIC GRIP Smooth, hard, ballotable mass suggestive of head

2ND PELVIC GRIP Fingers converge, head not engaged.

Uterus is relaxed

Fetal age = 28*8/7 = 32 weeks

Fetal weight = (28-12)*155 = 2480 gm


AUSCULTATION:

Fetal Heart sounds heard along the left spino-umbilical line

142/min, regular, rhythmic


DIAGNOSIS:
30 year old G3P2L2A0 with 32 weeks of gestation, moderate anemia probably due to iron deficiency,
not in labour with no clinical signs of failure.
**********************************************
2. CASE OF PREGNANCY INDUCED HYPERTENSION (PRE-ECLAMPSIA)
Name Narayanamma
Husbands Name Chandrababu
Age 20 years
Age 25 years
Occupation House wife
Occupation Driver
Address Dairy Circle
Income Rs.1700/per/month

Religion Hindu
Date of Admission 10/07/07

SE Status Upper Middle Class


Date of examination 12/07/07

G2P0A1 comes with 8 months of amenorrhea.


PRESENTING COMPLAINTS: Generalized edema since 10 days.
HISTORY OF PRESENTING COMPLAINTS:

Patient is a gravida 2 para0 presents with generalized edema since 10 days, insidious in onset,
initially noticed in the lower limbs which have gradually progressed to involve the upper limbs and
face. It is present throughout the day (no diurnal variation), not relieved by overnight rest nor by limb
elevation in the morning.

No history of headache, blurring of vision or syncopal attacks

No history of reduced urine output, hematuria.

No history of chest pain, palpitations or breathlessness on exertion or history suggestive of


cardiac failure.

No history of epigastric pain, nausea, vomiting.

No history of DM or HTN.

No history of jaundice, ascities before 20 weeks of gestation.


OBSTETRIC HISTORY:
Married Life 2 years (non consanguinous marriage)
Obstetric index G2P0A1
LMP 03/11/06
EDD 10/08/07
PREVIOUS PREGNANCY
G1 :

Painless spontaneous abortion at 6th month following bleeding PV. Patient had gone for 4 ANC
visits, 2 scans, booked and immunized.

No history of excessive vomiting.


(Rule out H. mole)

No history of HTN during pregnancy.


PRESENT PREGNANCY
T1

Morning sickness for 2 months present.

Increased frequency of micturation present.

No history of easy fatiguability.

No history of discharge or bleed PV.

No history of drug intake or radiation exposure.

No history of Pica.
T2

Quickening at 5th month.


No history of headache, blurred vision or sudden increase in weight.
Booked and Immunized 3 ANC visits, 2 TT, 100 IFA, Scan done at 20 th week.

T3

Fetal movements present.


No history of bleeding or discharge PV.
No history of pain abdomen.

Generalized edema present.


Last abortion 1 year back.

MENSTRUAL HISTORY:
Age of Menarche 16 years
Past Cycles Regular, 30 day cycle, 4 days flow, no pain or passage of clots.
LMP 03/11/06
No history of any contraceptives used.
FAMILY HISTORY: No history of DM, HTN, asthma, twinning in family. No history of PIH in mother or
sister.
PAST HISTORTY:
Medical No history suggestive of DM/HTN.No history of TB, epilepsy or asthma.
Surgical No history of blood transfusions or any previous surgical procedures.
PERSONAL HISTORY:
Diet Mixed
Appetite Good
Sleep Sound
Bowel & Bladder Regular
Habits Nil
GENERAL PHYSICAL EXAMINATION:
Here is a pregnant lady, moderately built and nourished, conscious, alert & cooperative; well oriented to
time, place and person.
Pulse
BP
RR
Temperature

86/min, regular, good volume


146/92 mm of Hg
18/min, regular
Patient is afebrile

Pallor
Present
Icterus
Absent
Cyanosis
Absent
Clubbing
Absent
Edema (pedal) Present, Pitting in nature
Lymphadenopathy Absent
Thyroid
Breasts
Spine
Gait

Normal
Normal
Normal
Normal

Height
Weight
BMI

160 cm
70 kg
27.3

SYSTEMIC EXAMINATION:
CVS S1 S2 heard, no murmurs.
RS NVBS heard, no additional sounds heard.
CNS Knee jerk present. Sensory, motor and cranial nerves normal.
PA Normal bowel sounds heard
OBSTETRIC EXAMINATION:
INSPECTION:

Abdomen uniformly distended.

Flanks not full.

Umbilicus everted.

Striae gravidarum, albicans & linea nigra present.

No scars over abdomen, no dilated veins.

Hernial orifices normal.


PALPATION: (Patient examined in supine position with legs semi flexed).

Fundal height corresponds to 32 weeks gestation.

SFH is 28 cm, abdominal circumference 85 cm.

Fundal grip Smooth, broad irregular structure suggestive of breech.

Lateral Grip Right Knob like structures suggestive of limb buds.


Left Uniform curved resistance suggestive of spine.

1st Pelvic Grip Smooth, round, hard ballotable mass (not engaged) suggestive of head felt at
lower pole
AUSCULTATION:

FHS heard along the left spino-umbilical line, mid point.

Rate 146/min, regular.


DIAGNOSIS:
20 year old G2A1 with 32 weeks gestation, single live fetus with cephalic presentation with head
not engaged and not in labour, with mild pre-eclampsia (on treatment) complicating her
pregnancy.
**********************************************
3. CASE OF PREVIOUS LOWER SEGMENT CAESAREAN SECTION
Name Anita
Husbands Name Venkatesh
Age 23 years
Age 24 years
Address Atmajyothinagar, Kengeri
Occupation Painter
Occupation Maid servant
Income Rs.2600/mnt
Religion Hindu
SE Status Lower Middle Class
Date of admission 09/07/2007
Date of examination 10/07/2007
G2P1L1 comes with 9 months of amenorrhea for safe confinement
HISTORY OF PRESENTING COMPLAINTS:

Patient comes with 9 months amenorrhea with a history of previous LSCS and was admitted for
safe confinement. Patient had been here for regular ANC checkup on 27/07/2007 and was asked to
get admitted as her EDD as per scan was 10/07/2007.
Patient complaints of backache since today morning in the lower mid-back, non-radiating and not
associated with pain abdomen.
Patient gives history of white discharge since 1 week, non-foul smelling, not associated with fever
or itching.
No history of leak PV or bleeding PV.
No history of hematuria.
No history of any change in bladder habits.
Fetal movements are well perceived.
No history of Diabetes mellitus or Hypertension.

OBSTETRIC HISTORY:
Married Life 4 years (non consanguineous marriage)
Parity index G2P1L1
LMP 01/11/06
EDD 08/08/07
PREVIOUS PREGNANCY:
T1

History of increased vomiting present.

History of easy fatigability.

No history of urinary symptoms.

No history of drug intake or radiation exposure.

No history of pica.
T2

T3

Quickening at 20th week.


History of generalized edema present.
No history of headache or blurring of vision.
Patient was booked and immunized 6 ANC checkups, 2 USG scans, 2 TT & 100 IFA.
Fetal movements present.
Uneventful.
Delivered by Lower Segment Caesarean Section probably due to obstructed labour or nonprogression of labour.
Patient was initially put n trial of labour by administering injections, but since labour pains were
not adequate, she was posted for emergency LSCS, after infusing 1 unit of blood.
Outcome was a live male fetus, 3.7 kg at birth, was immunized and exclusively breast fed for 1
year.
Mother had no fever or wound discharge in the post-op period.
Sutures were removed on the 7th day but had to stay in the hospital for 16 days as the baby had
jaundice.
Last C-section 3 years back (April 25th, 2004)

PRESENT PREGNANCY: T1, T2 and T3 uneventful. EDD-08/08/07


CONTRACEPTIVE HISTORY:
No history of using any contraceptive methods.

MENSTRUAL HISTORY:
Age of Menarche 12 years
Past Cycles Regular, 50-70 day cycle, 8-9 days flow, no pain or passage of clots.
LMP 01/11/06
No history of any contraceptives used.
FAMILY HISTORY: No history of DM, HTN.
PAST HISTORTY:
Medical No history suggestive of DM/HTN. No history of TB, epilepsy or asthma.
Surgical No history of blood transfusions or any previous surgical procedures.
PERSONAL HISTORY:
Diet Mixed
Appetite Good
Sleep Sound
Bowel & Bladder Regular
Habits Nil
GENERAL PHYSICAL EXAMINATION:
Mother is a young lady, moderately built and nourished, conscious, alert & cooperative; well oriented to
time, place and person.
Pulse
BP
RR
Temperature

78/min, regular, good volume


116/82 mm of Hg
18/min, regular
Patient is afebrile

Pallor
Present
Icterus
Absent
Cyanosis
Absent
Clubbing
Absent
Edema
Absent
Lymphadenopathy Absent
Thyroid
Breasts
Spine
Gait
Height
Weight

Normal
Normal
Normal
Normal
158 cm
51 kg

SYSTEMIC EXAMINATION:

CVS S1 S2 heard, No murmurs.


RS NVBS heard, no basal crepts.
CNS NAD.
PA NAD
OBSTETRIC EXAMINATION:
INSPECTION:

Distended and flanks are full.

Umbilicus normal.

Striae gravidarum, albicans & linea nigra present.

No dilated veins.

Hernial orifices normal.

A vertical right paramedian incision, 14 cm long is seen in the infra-umbilical region, healed by
primary intention no hypertrophy or keiloid formation, no supra-pubic bulge.
PALPATION: (Patient examined in supine position with legs semi flexed).

Fundal height corresponds to 32 weeks with flanks full corresponding to 40 weeks of gestation.

SFH is 32cm.

Fundal grip Broad, soft irregular structure suggestive of breech.

Lateral Grip Right Knob like structures suggestive of Limb buds.


Left Uniform curved resistance suggestive of spine.

1st Pelvic Grip Smooth, hard ballotable mass.

2nd Pelvic Grip Fingers diverge.

Abdominal girth 95 cm.

Weight of the fetus (Johnsons formula) = 3260 gm.

Age of fetus (Mc Donalds formula) = 40 weeks.

No scar tenderness.

No supra-pubic bulge felt.


AUSCULTATION:

FHS heard along the left spinoumbilical line, mid point.

Rate 140/min, regular.


DIAGNOSIS:
23 year old G2P1L1 with full term single intrauterine pregnancy with previous LSCS with
longitudinal lie with cephalic presentation not in labour.
**********************************************
4. CASE OF Rh NEGATIVE PREGNANCY
Name Savita
Husbands Name Satishchandra
Age 24 years
Age 28 years
Occupation House wife
Occupation Clerk
Address Chamrajpet
Income Rs. 1000/person/month
SE Status Lower Middle Class
Date of Admission 07/07/07
Date of examination 11/07/07
G2P1Lo comes with 7 months of amenorrhea for safe confinement.
HISTORY OF PRESENTING COMPLAINTS:

Patient comes with 7 months amenorrhea for safe confinement. Patient had been here for
regular ANC checkup on 5th July and was advised to get admitted telling her that her blood group does
not match with that of her baby (told to her by a private practitioner).
No history of generalized weakness and giddiness
No history of headache, blurred vision or decreased micturition
No history of edema and pruritis.
No other systemic complaints.

OBSTETRIC HISTORY:
Married Life 4 years (non consanguineous marriage)
Obstetric index G2P1L0A0D1
LMP 04/12/06
EDD 11/08/07
PREVIOUS PREGNANCY:

FTD at home, cried soon after birth, weight not measured.

Booked & Immunized, 5 ANC visits, 2 TT & 100 IFA.

The baby died 2 days after birth due to unknown reasons.


PRESENT PREGNANCY
T1

Morning sickness for 2 months.

No history of Urinary symptoms.

No history of Drug intake.

No history of Pica.
T2

T3

Quickening at 20th week.


No history of headache, blurred vision.
2 ANC visits, 2 TT, 100 IFA, 2 scans.
Fetal movements present.
No bleeding/leak PV.
In this pregnancy, she was evaluated & her blood group turned out to be B ve while that of the
fetus was O +ve
No Anti D injection given.
No history of abortion, LSCS or IUFD or invasive fetal procedure.
Previous baby blood group not known.
Last delivery 2 years back.

CONTRACEPTIVE HISTORY:
No history of using any contraceptive methods.
MENSTRUAL HISTORY:
Age of Menarche 15 years
Past Cycles Regular, 30 day cycle, 4 days flow, no pain or passage of clots.
LMP 04/12/06
FAMILY HISTORY: No history of DM, HTN.

PAST HISTORTY:
Medical No history suggestive of DM/HTN. No history of TB, epilepsy or asthma.
Surgical No history of blood transfusions or any previous surgical procedures.
PERSONAL HISTORY:
Diet Mixed
Appetite Good
Sleep Sound
Bowel & Bladder Regular
Habits Nil
GENERAL PHYSICAL EXAMINATION:
Mother is a 24 year old lady, moderately built and nourished, conscious, alert & cooperative.
Pulse
BP
RR
Temperature

82/min, regular, good volume


120/50 mm of Hg
18/min, regular
Afebrile

Pallor
Icterus
Cyanosis
Clubbing
Edema
Lymphadenopathy

Absent
Absent
Absent
Absent
Absent
Absent

Thyroid
Breasts
Spine
Gait

Normal
Normal
Normal
Normal

Height
Weight

156 cm
60 kg

SYSTEMIC EXAMINATION:
CVS S1 S2 heard, No murmurs.
RS NVBS heard, no basal crepts.
CNS NAD.
PA NAD
OBSTETRIC EXAMINATION:
INSPECTION:

Abdomen uniformly distended.

Flanks not full.

Umbilicus normal.
Striae gravidarum, albicans & linea nigra present.
No scars over abdomen, no dilated veins.
Hernial orifices normal.

PALPATION: (Patient examined in supine position with legs semi flexed).

Fundal height corresponds to 28 weeks gestation.

SFH is 25 cm.

Fundal grip Smooth, broad irregular structure suggestive of breech.

Lateral Grip Right Knob like structures suggestive of Limb buds.


Left Uniform curved resistance suggestive of spine.

1st Pelvic Grip Smooth, round, hard ballot able mass (not engaged) suggestive of Head felt at
lower pole.
AUSCULTATION:

FHS heard along the left spinoumbilical line, mid point.

Rate 140/min, regular.


DIAGNOSIS:
22 year old G2P1Lo with 7 months amenorrhea, single live fetus, not in labour with Rh ve
pregnancy.
**********************************************
5. CASE OF HEART DISEASE IN PREGNANCY 1
Name Chandrakala
Husbands Name Manjunath
Age 32 years
Age 35 years
Address Chikaballapur
Occupation Cloth merchant
Occupation Housewife
IncomeRs.2000/month
Religion Hindu
SE Status Upper Middle
Date admission 12/07/2007
Date of examination 12/07/2007
G3P1L1A1 comes with 9 months of amenorrhea for safe confinement of delivery.
HISTORY OF PRESENTING COMPLAINTS:

Patient comes with 9 months amenorrhea for safe confinement with a history of cardiac surgery.

No history of breathlessness on exertion, palpitations, chest pain, PND, orthopnea, edema of


feet.

No history of any congenital heart disease.

No history suggestive of CCF, infective endocarditis in the past or present pregnancy.


OBSTETRIC HISTORY:
Married Life 16 years (non consanguineous marriage)
Obstetric index G3P1L1A1
LMP 15/10/06
EDD 22/07/07
PREVIOUS PREGNANCY:
G1 FTND, Government Hospital, Now 11 years, Cried soon after birth, Weighed 3 kg, Post partum
period normal, Booked and immunized, 3 ANC visits, 2TT & 100 IFA received.

G2 Aborted at 1 months gestation (MTP) 6 years ago.


PRESENT PREGNANCY:
T1

History of nausea and vomiting.

No history of urinary symptoms.

No history of drug intake or radiation exposure.

No history of pica.
T2

Quickening at 18th week.


No history of headache or blurring of vision or edema.
Patient was booked and immunized 4 ANC checkups, 2 TT & 100 IFA.

T3

Increased frequency of micturItion present.


Fetal movements present.
Uneventful.

CONTRACEPTIVE HISTORY:
No history of using any contraceptive methods.
MENSTRUAL HISTORY:
Age of Menarche 15 years
Past Cycles Regular, 30 day cycle, 3 days flow, no pain or passage of clots.
LMP 15/10/06
FAMILY HISTORY: No history of DM, HTN. No history of any congenital heart disease among relatives.
PAST HISTORTY:

Patient underwent a cardiac surgery 2 years back when she developed sudden onset of
breathlessness though she was on medical treatment for some cardiac ailment for 5 years. Her
previous reports revealed that she was diagnosed to have RSOV with VSD. She underwent the
operation in a government hospital in Putbarti.

No history of fleeting joint pains or fever in the childhood and patient not on penidure prophylaxis.

No history of any post-op complications.

No history suggestive of DM or HTN.

No history of TB, epilepsy or asthma.


PERSONAL HISTORY:
Diet Mixed
Appetite Good
Sleep Sound
Bowel & Bladder Regular
Habits Nil
GENERAL PHYSICAL EXAMINATION:
Here is a pregnant lady, moderately built and nourished, conscious, alert & cooperative; well oriented to
time, place and person.

Pulse
BP
RR
Temperature

90/min, regular, good volume, normal character, all PP felt. JVP normal
130/70 mm of Hg
18/min, regular, TA
Afebrile

Pallor
Absent
Icterus
Absent
Cyanosis
Absent
Clubbing
Absent
Edema
Absent
Lymphadenopathy Absent
Thyroid
Breasts
Spine
Gait

Normal
Normal
Normal
Normal

Height
Weight

160 cm
60 kg

SYSTEMIC EXAMINATION:
CARDIO-VASCULAR SYSTEM:
INSPECTION

No precordial bulge.

Apical impulse left 4th inter-costal space, 2 cm lateral to Mid-cavicular line.

No other abnormal pulsations.

A linear scar seen over the mid-sternum 15 cm 2 cm.

No dilated veins over the chest wall.


PALPATION

Inspectory findings were confirmed.

Apex beat left 4th inter-costal space, 2 cm lateral to Mid-cavicular line.

No parasternal heave.

No thrill felt.

No abnormal pulsations.
AUSCULTATION
CVS

Aortic area
Pulmonary area
Mitral area
Tricuspid area

S1S2 heard, no murmurs.

RS NVBS heard, no basal crepts.


CNS NAD.
PA NAD
OBSTETRIC EXAMINATION:
INSPECTION:

Abdomen is distended, flanks are full.

Umbilicus normal.

Striae gravidarum, albicans & linea nigra present.

No dilated veins or scars or sinuses.

Hernial orifices normal.


PALPATION: (Patient examined in supine position with legs semi flexed).

Fundal height corresponds to 32 weeks with flanks full corresponding to 40 weeks of gestation.

Shelving Sign positive.

Symphysis fundal height is 30 cm.

Fundal grip Broad, soft, non-ballotable, relatively large irregular structure suggestive of breech.

Lateral Grip Right Knob like structures suggestive of Limb buds.


Left Uniform curved resistance suggestive of spine.

1st Pelvic Grip Smooth, hard ballotable mass relatively small felt suggestive of head.

Abdominal girth 104 cm.

Weight of fetus (Johnsons formula) 2800 gm.

Age of fetus (Mc Donalds formula) 40 weeks.


AUSCULTATION:

FHS heard along the left spinoumbilical line, mid point.

Rate 140/min, regular.


DIAGNOSIS:
32 year old G3P1L1A1 with full term pregnancy with cephalic presentation, not in labour with a
previous history of cardiac surgery.
**********************************************
6. CASE OF HEART DISEASE IN PREGNANCY 2
Name Farida Taj
Husbands Name Rehman
Age 25 years
Age 30 years
Address Chikaballapur
Occupation Plastic Items seller
Occupation Worker in Agarbatti factory
IncomeRs.3000/month
Religion Hindu
SE Status Upper Middle Class
Date of admission 08/11/2007
Date of examination 21/11/2007
Primigravida comes with 9 months of amenorrhea
PRESENTING COMPLAINTS:

Pain abdomen

Swelling of both lower limbs

Chest pain and breathlessness


HISTORY OF PRESENTING COMPLAINTS:

13 days.
13 days.
8 days.

Patient gives history of pain abdomen for the past 13 days, over the lower part of the abdomen,
moderate intensity, intermittent in nature, each episode lasting about 2 hours and approximately 2-3
episodes per day, relived on medication.
Patient also complaints of swelling of both the lower limbs since 13 days, insidious in onset,
initially present over the feet and has gradually progressed to the knee, present throughout the day,
increases on walking and relived on taking rest. No diurnal variation. No history of distention of
abdomen or puffiness of face.
Patient also gives a history of chest pain since last 8 days, sudden in onset, over the retrosternal
region, progressive, constricting type, non-radiation, moderate severity, aggravated on exertion and
relieved on rest. It is associated with breathlessness, insidious in onset, progressive in nature, initially
patient was able to do her routine activities but now she gets breathless after walking a few meters. It
is relieved on rest.
History of palpitations present.
No history of bleeding or discharge per vagina.
No history of orthopnea, PND.
No history suggestive of CCF, Infective endocarditis.
No history of fever.
No history suggestive of thyroid disease.
No history of any cardiac disease
Not a known case of DM or HTN.

OBSTETRIC HISTORY:
Married Life 1 years (non consanguineous marriage)
Parity index primigravida
LMP 03/03/07
EDD 10/12/07
PRESENT PREGNANCY:
T1

History of nausea and vomiting.

History of urinary symptoms present.

No history of drug intake or radiation exposure.

No history of pica, Booked and Immunized.


T2

Quickening at 5th month.


No history of headache or blurring of vision or edema.

T3

Fetal movements present.


Developed swelling of both lower limbs, chest pain and breathlessness as mentioned previously.

CONTRACEPTIVE HISTORY:
No history of using any contraceptive methods.
MENSTRUAL HISTORY:

Age of Menarche 15 years


Past Cycles Regular, 30 day cycle, 3 days flow, no pain or passage of clots.
LMP 03/03/07
FAMILY HISTORY: No history of DM, HTN. No history of any congenital heart disease among relatives.
PAST HISTORTY:

No history of fleeting joint pains or fever in the childhood and patient not on penidure prophylaxis.

No history suggestive of any other congenital heart disease.

No history of heart surgery.

No history suggestive of DM or HTN.

No history of TB, epilepsy or asthma.

No history of previous hospitalization or treatment for heart ailments.


PERSONAL HISTORY:
Diet Mixed
Appetite Good
Sleep Sound
Bowel & Bladder Regular
Habits Nil
GENERAL PHYSICAL EXAMINATION:
Mother is a young lady, moderately built and nourished, conscious, alert & cooperative; well oriented to
time, place and person.
Pulse
BP
RR
Temperature

99/min, regular, good volume, normal character, all PP felt. JVP raised (6 cm).
126/90 mm of Hg in left upper limb in supine position.
18/min, regular, TA
Patient is afebrile

Pallor
Absent
Icterus
Absent
Cyanosis
Absent
Clubbing
Absent
Edema
Absent
Lymphadenopathy Absent
Thyroid
Breasts
Spine
Gait
Height
Weight

Normal
Normal
Normal
Normal
160 cm
60 kg

SYSTEMIC EXAMINATION:
CARDIO-VASCULAR SYSTEM:
INSPECTION

No precordial bulge.

Apical impulse left 4th inter-costal space, 2 cm lateral to Mid-cavicular line.

No other abnormal pulsations.

No dilated veins over the chest wall, no scars.


PALPATION

Inspectory findings were confirmed.

Apex beat left 4th inter-costal space, 2 cm lateral to Mid-cavicular line.

Parasternal heave present.

No thrill felt.

No abnormal pulsations.
AUSCULTATION
CVS

Aortic area

S1 loud, S2 heard , No murmurs

Pulmonary area

ESM present

Mitral area

MDM present

Tricuspid area

S1S2 heard, No murmurs

RS NVBS heard, no basal crepts.


CNS NAD.
PA NAD
OBSTETRIC EXAMINATION:
INSPECTION:

Abdomen is distended, flanks are full.

Umbilicus normal.

Striae gravidarum, albicans & linea nigra present.

No dilated veins or scars or sinuses.

Hernial orifices normal.


PALPATION:

Abdominal circumference 76 cm

Symphysio-fundal height 28 cm (corresponds to 32 weeks)

FUNDAL GRIP Soft, broad & non-ballotable, suggestive of Breech

Lateral Grip Knob like structures on the right side suggestive of limb buds
Uniform resistance on the left side suggestive of spine

1ST PELVIC GRIP Smooth, hard, ballotable mass suggestive of head

2ND PELVIC GRIP Fingers converge, head not engaged.

Uterus is relaxed
AUSCULTATION:

FHS heard along the left spinoumbilical line, mid point.

Rate 140/min, regular.


DIAGNOSIS:

25 year old primi with full term pregnancy with cephalic presentation not in labour with cardiac
disease (valvular lesion), probably RHD, MS in sinus rhythm, not in failure with no evidence of
infective endocarditis.
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3 responses to CLINICAL CASES (OBSTETRICS)

1.
Ashi
May 2, 2011 at 8:15 pm

super stuff !! very helpful too !!


Reply

2.
ramya
January 10, 2013 at 12:22 am

thanks a lot sir. itz very helpful.


Reply

3.
Hasna
June 13, 2013 at 11:18 pm

Excellent work..really useful too..


Reply

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